Medicine

Europe, 1450 to 1789: Encyclopedia of the Early Modern World
COPYRIGHT 2004 The Gale Group Inc.

MEDICINE

MEDICINE. Medicine in the early modern era was characterized by several distinctive features. First, the understanding of illness and its treatment was based on assumptions that were inherited from antiquity and differed conspicuously from our own ideas. Second, physicians comprised but one group among a host of healers who routinely competed with each other for access to patients. Thus, in contrast to medicine today, physicians neither dominated nor directed the care of most of the sick. Third, the delivery of health care was not centered in hospitals or specialized clinics. Hospitals certainly were a feature of early modern medicine, but their role in the delivery of health care was minor. Last, and perhaps most important, people in early modern Europe inhabited a social, cultural, and demographic environment in which death intruded itself far more frequently in the everyday lives of Europeans than it does for people living in the developed world today.

PATTERNS OF DISEASE

Death was a common occurrence in the early modern period, a fact that colored nearly every aspect of social and cultural life. Nor was it just the elderly who expected to die; infants and children died at such high rates that someone could be counted fortunate just to reach the age of twenty-one, not to mention sixty or seventy. This depressing fact was not lost on contemporaries. "Of each 1,000 people born," wrote a German physician in 1797, "24 die during birth itself; the business of teething disposes of another 50; in the first two years, convulsions and other illnesses remove another 277; smallpox . . . carries off 80 or 90, and measles 10 more." Of every 1,000 people born, he concluded, "one can expect that only 78 will die of old age or in old age." Although we cannot verify the accuracy of these numbers, there is no disputing the appallingly high mortality rates they indicate. Available records of baptisms and burials from local churches suggest that in countries such as France and Denmark, deaths of infants (that is, children under the age of two) from all causes could climb as high as two hundred or more deaths per thousand births.

A variety of factors contributed to these high mortality rates, including the prevalence of malnutrition and intestinal parasites. Although these may have only rarely caused death directly, they undoubtedly weakened the body's defenses against disease. More directly responsible were infectious diseases like smallpox and measles, mentioned in the quotation above, along with other serious childhood diseases like diphtheria, whooping cough, and dysentery.

The most dangerous disease of all was the plague, which first struck various parts of Europe between 1347 and 1351 and returned to afflict almost every generation until the very end of the seventeenth century. The disease is believed to have begun in China and then spread along trade routes in Central Asia in the early 1340s. By 1346 it had reached the Crimean city of Caffa, and from there it was brought to Sicily and southern Italy. Once established there, plague spread, again along trade routes, to other parts of Europe. Skepticism has grown in recent years over whether the plague (caused by the bacterium Yersina pestis ) was exclusively bubonic plague, induced in its victims by the bite of a flea, or whether it was mixed with a more dangerous airborne form known as pneumonic plague. It is possible too that one or more other diseases were also part of the mix. Whatever its precise cause, there can be no question that plague hit many parts of Europe hard. Over the entirety of Europe, it is estimated that the first onset of plague killed approximately 25 percent of the population, although actual mortality varied considerably from place to place. Even as late as the seventeenth century, outbreaks of plague continued to hit with devastating impact. In 1656–1657, the Italian city of Genoa lost 60 percent of its population of 75,000 to plague—a horrific, although unusually high, mortality rate—while between 1609 and 1611 about 42 percent of the residents of the Swiss city of Basel (population 15,000) caught the plague and 62 percent of those victims died.

A second serious disease, syphilis, appeared for the first time in Europe at the very end of the fifteenth century. While having nowhere near the demographic
impact of plague in terms of deaths caused by it, syphilis was serious enough, especially in the virulent form in which it first appeared. The disease was first reported during the French army's campaigns in Italy during 1494–1495 (hence the common name given it, the "French Pox"), and from there it spread rapidly throughout Europe. Sufferers from syphilis, reported the German scholar Ulrich von Hutten in the early sixteenth century, "had boils that stood out like acorns, from which issued such filthy stinking matter, that whosoever came within the scent believed himself infected." The stinking stain described by von Hutten could have been more than just physical, for it was soon determined that syphilis was sexually transmitted, thus giving the disease extra significance as an apparent punishment for sinful promiscuity.

THE ORIGINS OF PUBLIC HEALTH

Historians once commonly believed that plague was a primary cause of the breakdown of medieval society and the transition to the modern era. Although this is no longer widely accepted, there is no denying that plague did have a powerful impact. Arguably the most significant of its effects was the stimulus it provided to the development of public health, and, more speculatively perhaps, to the more general idea that the purpose of government was to formulate policy, not just maintain order. The idea that the government could exercise a regulatory and policy-making function was certainly not unprecedented in the late fourteenth and early fifteenth centuries, but the horrific consequences of repeated plague outbreaks made matters of health a particular focal point of concern and regulation.

As early as 1348, the town council of Venice appointed three of its members as a special commission to devise measures against the plague that had broken out there, and, in general, highly developed Italian cities like Florence, Milan, and Genoa were among the earliest to formulate measures against the plague. Many European cities and principalities north of the Alps followed suit during the next 150 years. The measures taken by these boards included the institution of quarantine, a practice whereby plague victims were shut up in their houses, together with their families and servants, if they had any. Quarantine could also be placed on entire towns and cities, and because such bans could last for weeks or even months, a declaration of quarantine had serious consequences for trade and economic well-being. Plague ordinances further specified how those who had died of plague should be buried and what should be done with their personal possessions—clothing and bedding could be burned, for example. More controversially, they also prohibited public gatherings of different kinds, including church processions. Since such public gatherings were a major component of medieval Catholic spirituality, their prohibition by secular authorities was a recurrent source of conflict with the church.

Throughout the fifteenth century, most of the health commissions charged with dealing with plague remained temporary institutions, dissolving as soon as the threat posed by the current epidemic had subsided. But during the sixteenth century, more permanent health magistracies began appearing in northern Italian cities. The responsibilities given these boards gradually evolved to cover not only times of emergency but also the more routine supervision of public health. Justified by a desire to forestall future outbreaks of plague and building on prior medieval attempts to enforce sanitary standards in larger cities (in some cases dating much further back than the 1340s), these health boards began formulating more comprehensive sanitary measures to control such things as the cleaning of streets and dumping of wastes. Beggars and Jews, who were suspected of being transmitters of disease, were often singled out for unwelcome attention.

A somewhat different system evolved in German-speaking central Europe during the sixteenth and seventeenth centuries. There, towns and principalities began appointing a local physician or surgeon to the partially salaried post of physicus. Their primary responsibility normally involved providing medical care for the poor, but physici were also charged with enforcing sanitary regulations, instructing and supervising other practitioners, and conducting medical-forensic inquiries, among other functions. In effect, these practitioners served as the instruments for the enforcement of public health ordinances, while at the same time gathering information about local health conditions that could be transmitted back to the political authorities.

THE INSTITUTIONS OF CARE

To the extent that early modern medical care was centered in institutions of any kind and did not simply take place at the patient's bedside or in the practitioner's shop, hospitals provided that institutional setting. But this statement must be immediately qualified by noting that hospitals served almost exclusively the needs of the poor. Not until the early twentieth century, in fact, would people who were not poor begin using hospitals in any considerable numbers. Moreover, hospitals in the early modern era were not devoted exclusively to medical care, offering instead a spectrum of charitable support for the poor.

The roots of hospitals as integrated charitable/medical institutions go back many centuries, on the one hand to the social welfare needs of large urban centers of late antiquity and the early Middle Ages, such as Constantinople (modern-day Istanbul) and Baghdad, and on the other hand to the hospices established for travelers and the poor by early Christian communities. As monastic communities spread across the Christian world during the Middle Ages, many of them, especially those located on important trade routes or destinations for pilgrimages, established small infirmaries for sick members of their communities and travelers who had no other support during times of illness. Eventually, hospitals of varying sizes became an established feature of the urban landscape, funded by the charitable endowments of individual patrons or local religious organizations, such as confraternities.

By the sixteenth century, and especially in the wake of the Reformation, hospitals were confronted by significant new challenges. First, conversion to Protestantism often involved confiscation by the ruler of church properties, which deprived hospitals both of the assets that supported their operation and sometimes of the personnel who ran them. In England, Henry VIII's break with the Roman Church in the 1530s led to wholesale seizure of church properties, including those supporting the three London hospitals of St. Thomas, St. Bartholomew, and Bethlehem. This immediately threw the city's charitable services into chaos, and the city's leaders implored the crown to restore the funds necessary to operate the hospitals. This the crown did over the course of the next twenty years, yielding for London a total of five major hospitals: St. Thomas's and St. Bartholomew's for the sick poor; Christ's for orphans; Bridewell for the shiftless poor, and finally, Bethlehem (known later as "Bedlam") for the mentally ill.

The functional "specialization" displayed by different London hospitals was by no means the standard in the period, and many hospitals, such as the huge Allgemeines Krankenhaus in Vienna or the Julius-Spital in Würzburg, folded various charitable services into one institution. What they did share with the London hospitals was the specific range of charitable activities. Just as importantly, the hospitals of the sixteenth and seventeenth centuries displayed a new attitude about the poor. This attitude was reflected in a separation made between the "virtuous" poor, such as the aged, widows, and children, and the "shiftless" or "lazy" poor, a separation that still resonates in welfare today. In a period when the poor were increasingly viewed as a possible threat to social order, hospitals became places for housing the poor and removing them and their supposed threat from the streets. By 1700, this thinking had led in France to the founding of more than one hundred so-called hôpitaux-généraux (general hospitals), institutions in which the deserving and undeserving poor were rounded up together, with the former supposedly receiving benevolent shelter in their time of need and the latter corrected and improved by a combination of enforced labor and religious discipline.

All of these institutions, even those resembling prisons and workhouses, offered treatment for the sick. By the eighteenth century, the curing of patients and their return to useful roles in society became more clearly the focal point of the hospital's identity. Although they remained charitable institutions, supported largely by private philanthropy or government subventions instead of patient fees, hospitals discouraged the admission of the chronically sick or aged, pregnant women and children—in short, the traditional clientele who had populated hospitals in previous eras. Instead, they focused on curing and releasing what came to be known later as the "laboring poor," those who held regular jobs and had fallen ill.

MEDICAL PRACTITIONERS

Today, the treatment of illness is usually given by a physician, that is, someone with a university medical
education in possession of an M.D. Although other people, such as nurses or pharmacists may be involved in this process, physicians direct it. In the early modern era, that was decidedly not the case. Physicians formed but one small group among a variety of healers, any of whom could be consulted in time of sickness.

Among the other healers who competed for access to patients, surgeons were probably the most prominent. Like physicians, surgeons were a recognized occupation, often organized in larger towns into guilds that supervised professional standards and trained apprentices in the craft. In both the popular imagination and in their own professional identities, physicians and surgeons were separated by their domains of practice: physicians treated internal ailments, while surgeons handled external maladies, including wounds. Physicians were not trained to cut patients most of the time, while surgeons made liberal use of the knife, even if they also administered medications. Their use of the knife is a principal reason why surgeons often were grouped together occupationally with lower-status barbers, who not only cut hair but also performed routine medical procedures such as bloodletting.

However, because the boundary between "internal" and "external" is by no means obvious in every case, many diseases, such as cancerous tumors and syphilis, were often treated by surgeons. Therefore, rather than seeing physicians and surgeons as having clearly demarcated areas of competence, it would be more accurate to understand them as having overlapping spheres of practice, where the choice of healer more often depended on factors such as personal acquaintance, reputation, and availability, and not on a calculation of which healer was most appropriate for any particular illness. Part of the distinction between physicians and surgeons can be explained in terms of social hierarchy. Because physicians were university educated and participated in the literate, Latinate culture of the urban and courtly elites, they tended to enjoy higher social status than surgeons. But neither the status of healers nor the choice of healer by patients was determined along a gradient of social hierarchy. Kings and bishops were just as likely as a common artisan to consult a surgeon when the need arose—although not, of course, necessarily the same surgeon.

The same point could be made for other established healing occupations, midwives and apothecaries. Midwives were women who attended births and cared for the mother and newborn child during the first days after birth. In principle, they were not supposed to treat patients outside the context of birthing or to administer drugs, apart from those useful during or immediately after labor. But, in fact, midwives were consulted more widely, especially by women, whose trust in the midwife would have been cemented by her assistance during their children's births. Apothecaries were dealers in herbal medications, grocers who knew how to extract the healing virtues from natural products. Physicians expected apothecaries to dispense medications to patients only on the orders of a physician. But here too, the prescribed division of labor was easily breached by apothecaries who believed that they could just as well (or better) determine the appropriate medicines to give people suffering from particular ailments. From the patient's point of view, the decision to consult an apothecary or midwife might depend on the same considerations as those mentioned above—personal acquaintance, local reputation and accessibility—as well as cost. In most cases, it cost considerably less to bring a midwife or apothecary in than a physician.

During the later seventeenth and eighteenth centuries, governments in various parts of Europe began paying a great deal of attention to how practitioners were trained and to keeping practitioners from infringing on others' domain of work. Surgeons, whose training had always swung between guild apprenticeships and university-based anatomy theaters (although surgeons did not routinely hold M.D. degrees), increasingly saw their training based in the newer hospitals or specially instituted surgical academies. The training and qualifications of midwives and apothecaries likewise came under closer scrutiny, and in a number of places they were required to submit to licensing examinations. The establishment of a separate licensing examination for physicians after awarding the M.D. also came into much wider use, when, for example, in 1651 the electorate of Bavaria created a collegium medicum that was authorized to examine every physician who wished to practice in its territory.

The practitioners described here by no means exhaust the full range of healers present in early modern
society. These other healers are represented, in part, by folk healers, who deployed a wide range of traditional therapies. The use of magical or religious invocations in treating illness, of course, was probably not a rare occurrence at this time. In addition, the early modern period was populated by a host of itinerant drug peddlers, stonecutters, and sundry charlatans who sold special talents or products in the medical marketplace. By the mid-eighteenth century, and as a result of the dramatic expansion of the press, medical products and services participated in a booming advertising market.

IDEAS OF HEALTH AND ILLNESS

The dominant medical thinking of the early modern period saw health as dependent on a particular balance in the body's four humors, known conventionally as blood, phlegm, black bile, and yellow bile. Each individual humor, in turn, manifested a distinctive combination of qualities from the pairs wet/dry and cold/hot. Thus, blood was believed to be hot and wet, yellow bile, hot and dry, and so on. The balance of humors required to maintain health was highly individual, depending on someone's age, sex, local environment, diet, work, lifestyle—in principle, almost anything could influence health. Excessive exercise, for example, could cause the body to heat up, resulting in an excess of blood or yellow bile. Scholars, on the other hand, were thought to suffer from particular diseases resulting from their having too little exercise and too much brainwork. The prevention of illness and its cure
depended in principle on the same idea, whereby the practitioner sought to maintain or restore the proper humoral balance. The application of many treatments, such as the use of bloodletting or emetics (agents that cause vomiting), can be understood as working in this way.

Over against these doctrines concerning pathology and therapeutics must be set a partially separate set of ideas concerning what we now call physiology, the functions of the living body. The body's functions were thought to be governed by three principal organs: the liver, which converted nutritive juices produced by digestion into blood, which was then sent via the venous system to all parts of the body and nourished it; the heart, which mixed air taken in by the lungs with some blood, producing vital spirit, which was distributed throughout the body by the arteries and governed vital processes such as motion, breathing, and digestion; and the brain, which produced animal spirits, responsible for the higher functions of sensation and consciousness, and which traveled throughout the body via the nerves. Although not entirely divorced from the humoral doctrines that molded thinking about health and illness, the theories governing physiology were formulated to answer a distinctive and separate set of questions, such as what breathing does or how the movement of muscles occurs.

The source of many of these ideas was a collection of writings attributed to the ancient Greek physician Hippocrates (c. 460 b.c.e.–375 b.c.e.), especially as interpreted by the later Greek physician Galen (129–199? c.e.). Very few of Hippocrates' and Galen's writings were available in Latin translation during the early Middle Ages, but a far richer view of Hippocratic and Galenic medicine started appearing in Latin-speaking Europe at the end of the eleventh century, when translations of Arabic medical writings were made in southern Italy and Spain. These encyclopedic compendia of ancient medicine became the basis for medical teaching in the universities that began appearing at the end of the twelfth century.

By the early sixteenth century, medicine was a widely accepted part of the university curriculum, with the teaching of theory and practice based largely on Hippocratic and Galenic precepts, as interpreted and synthesized by medieval Muslim scholars. A second wave of translations, beginning in the late fourteenth century and inspired by the humanist cultural program for the restoration of classical antiquity, produced a wave of Latin translations from ancient Greek manuscripts, bypassing the mediation and (so the humanists claimed) the barbarism of earlier Muslim translators and commentators. The output from all this effort is astonishing: between 1500 and 1600, there are said to have been approximately 590 different editions of Galen's writings. To a surprising extent, these new translations from Greek sources did little to change the curriculum or the dominant medical theories. Yet in one important area, anatomy, the recovery of Galen's writings, especially his On Anatomical Procedures (first published in 1531), a guide to dissection, did lead to dramatic changes in medical thinking.

The conduct of dissections as part of the teaching of anatomy was a well-established, if also a sporadic, part of the medical curriculum. Well before 1500, medical scholars had used dissection as a means of engaging in critical dialogue with their ancient and medieval Muslim predecessors, to the extent that these sources were available to them. The appearance of On Anatomical Procedures in Latin translation, however, gave to humanistically inclined physicians an impeccably ancient source of authority for the practice of dissection, as well as practical tips for doing so. Consequently, anatomy and the practice of dissection acquired a status far exceeding what it had enjoyed before, and knowledge of human anatomical structure became a focal point of research interest. This burst of activity culminated with the publication of De Humani Corporis Fabrica (1543; On the structure of the human body), by Andreas Vesalius, the most renowned anatomist of the era. Vesalius's richly illustrated text presented itself as an extended critique of Galen's claims about anatomy, offering its readers a far more visually concrete picture of the body than anything previously available.

The critique of Galen's anatomical ideas, however, did not translate immediately into a broader abandonment of his physiology, in part because his theories about the body's functions made a great deal of sense in the context of physicians' experiences with the bodies of their patients. Only in the greatly changed circumstances of the seventeenth
century, when a new generation of scholars deployed a new "mechanical" philosophy based on experiment to overthrow the entire edifice of ancient natural philosophy and the kinds of explanations it offered, did physicians shift from engaging in their centuries-long critical dialogue with their ancient sources to thinking about the body's functions in ways that departed significantly from ancient models. The most important among these later physicians was William Harvey (1578–1657), a highly skilled anatomist and experimentalist whose carefully designed investigations into the function of the heartbeat, published in 1628 as Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus (An anatomical essay on the motion of the heart and blood in animals), directly attacked the physiological role assigned to the heart by Galen, suggesting instead that the heart acts as a pump, distributing blood to the body through the arteries and receiving it back again from the veins.

BIBLIOGRAPHY

Cook, Harold, J. "The New Philosophy and Medicine in Seventeenth-Century England." In Reappraisals of the Scientific Revolution, edited by David C. Lindberg and Robert S. Westman. Cambridge, U.K., 1990.

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Medicine

Encyclopedia of Science and Religion
COPYRIGHT 2003 The Gale Group Inc.

Medicine

Religion and medicine are twin traditions of healing. Although they have overlapped for most of their history, in the past three hundred years the two traditions have become separate and have often been in competition with one another. At the close of the twentieth century, serious consideration began to be given to reintegrating religion and medicine. In this discussion, a review of the historical connection between these two traditions will be offered. Research that has led to a possible rapprochement will be examined as will the implications for practicing clinicians.

Historical background

There is a long historical tradition that connects religion and medicine. The first hospitals in western civilization for care of the sick in the general population, particularly for those unable to pay for their own care, were built by religious groups. In the fourth century, Basil, the Bishop of Caesarea established one of the earliest hospitals based upon the good Samaritan story in the Bible. This building was resurrected in present-day Turkey among almshouses and leper colonies. For the next thousand years, the church would build and staff most hospitals throughout the western world. Many early physicians, especially those in Europe during the Middle Ages and in the New England colonies of the United States during the seventeenth and eighteenth centuries, were also members of the clergy. In Europe, licenses to practice medicine were in fact controlled by the church and church-sponsored universities.

Similarly, the profession of nursing was to emerge out of the Christian church in the 1600s and 1700s with the Daughters of Charity of St. Vincent de Paul, an order of Catholic sisters devoted to the care of the sick. The Daughters of Charity also established the first nursing profession in the United States in Emmitsville, Maryland, in the early 1800s, modeled after nursing in France. Florence Nightingale (1788–1849), after receiving a "calling" from God, would later receive nurses training from the Daughters of Charity and the Protestant deaconesses (started up by Lutherans in Germany). After the Crimean War, Nightingale applied what she learned to a secular setting. Interestingly, though, up until the early 1900s, most hospitals in Europe and the United States continued to be staffed by nurses who were primarily from religious orders.

Beginning in the fifteenth century, the profession of medicine began to split away from the church, and the state took over the role of administering licenses to practice medicine. That separation would continue to widen until the early 1800s when it was nearly complete. For the last two hundred years, religion and medicine have been divided into separate healing disciplines, with very little overlap and very little communication between the two. However, since about the mid-1990s, especially in the United States, there has been active dialogue about bringing religion and medicine together once again. This movement has been highly controversial and has met with considerable resistance. A growing volume of research showing a connection between religion and health, however, has been breaking down the resistance.

Although the history reviewed above applies primarily to the Christian church, there has been similar interest in health and healing running through nearly all the major world religious traditions, including Judaism, Hinduism, Buddhism, Islam, and Chinese religions. Space does not allow for an adequate discussion of historical connections with medicine for each of these traditions, although resources that do so include Lawrence Sullivan's Healing and Restoring: Health and Medicine in the World's Religious Traditions (1989) and Caring and Curing: Health and Medicine in the Western Religious Traditions (1998) by Ronald Numbers and Darrel Amundsen.

Research on religion and health

The recent trend towards integration of religion and medicine has been stirred primarily by medical research demonstrating intimate and often complex relationships between religion and health. First, many patients indicate that religious beliefs and practices help them to cope with the stress of medical illness. In some areas of the United States, nearly ninety percent of hospitalized patients report that they use religious beliefs to at least a moderate degree to help them to cope. Nearly fifty percent of this group indicate that religion is the most important factor that enables them to cope with medical conditions and the stress they cause. Over one hundred studies have now documented the high prevalence of religious coping among persons with a variety of diseases ranging from diabetes, kidney disease, heart disease, cancer, arthritis, and cystic fibrosis, to more general conditions such as chronic pain.

There is also research demonstrating that persons who are religious end up coping better with physical health problems and disabling conditions. Of nearly one hundred studies conducted during the twentieth century on the relationship between religion and emotional well-being (happiness, life satisfaction, optimism, and hope), nearly eighty percent find that the religious person experiences significantly greater well-being. This is particularly true when populations of medically ill subjects have been studied. The religious are less likely to become depressed or anxious, and if they do develop these mental conditions, they recover more quickly. Suicide is less common among the more religious, as is marital dissatisfaction and divorce, and alcohol and drug use. Nearly 850 studies have now examined these associations, with between two-thirds and three-quarters of these finding that the religious person tends to be healthier and better able to cope with illness.

Of course, a number of studies also report that religion can be associated with worse mental health, more depression, and greater anxiety. This is particularly true for practitioners of religions that are repressive, controlling, and do not emphasize caring for self and others in a responsible way. Religion can be used to justify hatred, aggression, prejudice, and social exclusion. It may induce excessive guilt in situations where guilt is not healthy. Religion may also be used to replace professional psychiatric care for serious mental or emotional problems that require medication and biological therapies. In all of these ways, religion may do a disservice to mental health. In most cases, however, the emotional benefits of religious faith tend to outweigh the negative effects.

There is also a growing volume of research suggesting that religious belief and practices are related to healthier lifestyles, better overall physical health, and longer survival. Studies demonstrate stronger immune functioning among religious persons who are older, who are HIV positive or have AIDS, or have breast cancer. Death rates from coronary artery disease are lower among the more religious, even when health behaviors, diet, and social factors are taken into account. The same applies to mortality from all causes. Since 1990, over a dozen careful studies have demonstrated that the religious person lives longer than the person who is less religiously involved. In these studies, religion is measured by frequency of church attendance, private prayer and scripture study, meditation, and religious coping. Studies have not demonstrated that the broader aspect of religion called spirituality is associated with greater longevity. Spirituality is a broad concept, making it difficult to measure, whereas religious beliefs, practices, and commitment can be more easily assessed and quantified.

Why does religious belief and practice correlate with and predict greater physical health? The answer may lie in the mind-body relationship. There is growing evidence suggesting that emotions influence physiological processes. Psychological stress, anxiety, and depression have been related to impairments in immune functioning, delayed wound healing, and increased risk for cardiovascular morbidity. If religious beliefs and practices reduce emotional stress, counter anxiety, and prevent or facilitate recovery from depression, then religion may help to neutralize the health-impairing effects that these negative emotions have on physical health, and do so through known biological pathways. Mainstream scientists in the field of psychoneuroimmunology are beginning to explore these connections more seriously.

Since about 1980, people have become increasingly disillusioned with medical care that relies solely on high technology and focuses on the biology of disease, while neglecting the care of the whole person. That disillusionment has caused many patients to express a desire to have their spiritual and emotional needs met, as well as their physical needs. Between one-third and two-thirds of patients consistently indicate that they wish their physicians to address religious or spiritual needs in addition to medical needs, particularly when they experience serious medical problems or terminal illness.

Furthermore, there is research indicating that religious and spiritual beliefs impact medical decision making and may even affect compliance with medical treatment, making it essential for physicians to know about these beliefs. Some patients may use religion instead of traditional medical care to treat their illnesses. For example, they may decide to pray for their illnesses and stop taking their medications. There is also research showing that certain types of negative religious beliefs may adversely affect physical health and recovery from medical illness. Patients who feel punished or deserted by God, who question God's power and love, or who feel abandoned by their spiritual community, experience greater mortality and worse mental health outcomes.

Application to medical practice

The growing body of research on religion and health suggests at least the following four applications to medical practice in the West. First, in light of this research, some have argued that physicians should consider taking a spiritual history on patients with serious, terminal, or chronic medical illness. In the United States, only about one in ten physicians consistently addresses spiritual issues by taking a religious history, despite suggestions by a consensus panel of the American College of Physicians and American Society of Internal Medicine that such a history can be obtained by asking a few simple questions. Such questions include the following:

Are religious beliefs a sense of comfort or a source of stress for the patient?

Is the patient a member of a spiritual community and is this a source of support for the patient?

Does the patient have any religious belief that may influence medical decisions or conflict with medical care?

There any religious or spiritual needs present that need addressing?

Taking a spiritual history should be done in addition to (not instead of) competently and completely addressing the medical issues for which the patient seeks help from the physician. Thus, a spiritual history is most appropriate when there is more time in the schedule, such as during a new patient evaluation or during a hospital admission workup.

Second, if spiritual needs are identified when the spiritual history is taken, then the research suggests that addressing those needs should improve the health and coping capacity of the patient. This can be done in a couple of ways. The patient can be referred to a trained clergyperson or chaplain. Chaplains in the United States are required to undergo extensive training that prepares them to address such issues in the medical setting. Before a chaplain is certified in the Association of Professional Chaplains, he or she must complete four years of college, three years of divinity school, one to four years of clinical pastoral education, and must take written and oral examinations. Thus, chaplains are skilled professionals with much to offer in this area. Sometimes, however, patients do not wish to speak with a chaplain or clergyperson. In that case, if the patient already has a trusting relationship with the physician, then the physician may need to be prepared to address such issues, even if this involves only listening and showing respect and concern. Nearly two-thirds of the medical schools in the United States have elective or required courses on religion, spirituality, and medicine. In these courses, medical students are trained to take a spiritual history and to address spiritual issues in a sensitive and appropriate manner.

Third, in addition to taking a spiritual history and, if necessary, addressing spiritual issues, the physician may choose to support healthy religious beliefs or practices that the patient finds helpful in coping with illness. Physicians should not prescribe religion for patients who are not interested in religion. There may be benefits, however, in physicians learning about the religious beliefs and practices of their patients and supporting those beliefs that the patient finds helpful and that do not conflict with medical care. Even when religious beliefs conflict with medical care, the patient is likely to profit when the physician tries to understand those beliefs and keep open lines of communication about religious issues with the patient. By way of supporting religious practice, some physicians have decided to pray with their patients. This activity is highly controversial in the medical setting. Conditions for its appropriateness include that:

A spiritual history has been taken and the physician knows about the religious background of the patient.

Religion is important to the patient and is used in coping.

The religious background of the patient and the physician are similar.

Either the patient asks the physician to pray (i.e., patient initiates the prayer) or, if the physician initiates it, the physician is certain that the patient would appreciate this activity.

Under such circumstances, it may be helpful for a physician and patient to engage in prayer together, enhancing the doctor-patient relationship by increasing trust.

Finally, the research suggests that new social arrangements for medical care may prove beneficial. For example, physicians might develop a communication network with local clergy, both to facilitate a referral base and to allow physicians to assess the community resources that are available to the patient. Religious communities often already provide volunteers to assist with homemaker services, rides to the doctor, respite for exhausted family members caring for the patient, and emotional support to the patient and the patient's family. Religious communities may also monitor the patient to ensure that the medical regimen is being followed and that medical problems are detected early and treatment is obtained promptly. Such a system works especially well when volunteers are appropriately trained and coordinated by a parish or congregational nurse—a registered nurse who is a member of and works professionally as a nurse within the congregation. A parish nurse can coordinate health programs within the congregation that involve screening for high blood pressure, diabetes, depression, and other diseases. A parish nurse can also provide spiritual care, communicate with physicians and nurses within the formal healthcare setting about the health condition of members of the congregation, train and mobilize volunteers within the religious community to meet the needs of sick members, and provide health education to keep healthy members well.

Religion and Western medicine are indeed coming closer and closer together. The research suggests that this is a positive trend—good for the health of patients and for the maintenance of the health of the community. It is also arguably good for the profession of medicine in the West, which is truest to its most basic aims when its practices support the health of the patients in every dimension.

See also Mind-body Theories; Placebo Effect; Spirituality and Health; Spirituality and Faith Healing

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Medicine

Encyclopedia of Food and Culture
COPYRIGHT 2003 The Gale Group Inc.

MEDICINE

MEDICINE. Food plays both a causative and curative role in health and disease. Thus, its role in medicine may be as a risk factor for, protector against, or treatment of an illness. While too much food or exposure to certain foods can reduce someone's health, too little food or inadequate amounts of certain foods can be equally damaging. In the years before modern transportation, packaging, and refrigeration, medicine was primarily concerned with food deficiencies and food spoilage. The focus of medicine was on the identification of critical components of food and common pathogens and on the prevention of nutritional deficiencies and foodborne infections. The role of food in medicine has changed as food production, preservation, and preparation techniques have progressed. Today far more people in developed countries such as the United States suffer from excessive food consumption than from food deficiencies. In addition, certain components of food have been found to have therapeutic or protective properties when administered in levels greater than generally considered necessary. For instance, large quantities of vitamin A are used to treat acne, therapeutic quantities of vitamin E may be protective against heart disease, and extra fiber appears to reduce the risk of colon cancer. However, the problems of malnutrition or inadequate food intake and foodborne illness have not been eliminated. Undernutrition continues to plague developing nations, while the prevention and treatment of foodborne illness is a concern for all nations.

The Basics of Food and Health

Food is fundamental to support life. People get energy, water, and all of the building blocks for growth and proper bodily functioning from the foods they eat and the liquids they drink. The components of food necessary to life are termed "nutrients" and the study of the role of food in health is called nutrition. The goal of medicine is to ensure health, and because adequate nutrition is necessary to accomplish this, nutrition is a crucial component of medicine. Nutritional science combines food science and medical science. Nutrients include protein, fat, carbohydrates, fiber, thirteen vitamins, seventeen minerals, and more substances that are still being identified. The majority of nutrients essential to health are found in a variety of different foods. No one food is absolutely essential to support life. People with access to adequate amounts of food get all of the nutrients they need by eating a varied diet complete with fruits, vegetables, meat or meat alternatives, dairy foods, and grains. However, some people are not able to or do not choose to eat the full variety of foods available. These people may require special foods or supplements to meet their nutritional needs.

The Study of Food in Medicine

All branches of medicine, from pediatrics to geriatrics and from internal medicine to surgery, study food and its role in health and disease. Nutritional scientists in government, industry, and academia are constantly seeking to understand the role food plays in illness and well-being. Meanwhile health-care practitioners treat patients with nutritional plans and food supplements. Registered dietitians are health-care specialists who integrate food into medical treatment—this is referred to as medical nutrition therapy.

The Role of Food in Maintaining Health

Although the presence of adequate nutrition does not ensure health, it is a significant contributor. The energy contributed by the protein, carbohydrates, and fat in food provides the fuel for every element of body functioning from breathing to thinking to fighting disease to running
marathons. Adequate energy intake is crucial to promote proper growth and development as well as to maintain healthy functioning once one is fully grown. Food also provides the materials necessary to build healthy bone, muscle, skin, hair, etc. For example, bone is a complex matrix of calcium, phosphorus, and collagen fibers. A person's bone strength is directly related to their nutrient intake such that inadequate calcium intake is one of the primary reasons for bone disease such as osteoporosis. Nutrients are also necessary to support proper chemical and neurological functioning. For example, fat insulates nerve fibers such that they can conduct electrical signals along the length of the body. Meanwhile, those electrical signals are generated via channeling ions such as sodium, potassium, and calcium into and out of the nerve cells. Finally, the neurotransmitters released from the nerve cells are made from amino acids contributed largely from proteins in the diet. Thus, thinking and feeling are intricately connected to food.

Food for Those Who Can't Feed Themselves

Food is generally eaten, or drunk, and swallowed. However, many people cannot obtain adequate nutritional levels by conventional ways of ingesting food. In the past, these people would suffer and die from malnutrition. Modern nutritional medicine offers people several alternatives to conventional chewing and swallowing of food so that those who cannot do so will not die. Liquid solutions have been manufactured by pharmaceutical companies that are easier to digest than solid food and provide 100 percent of nutritional needs. People who can drink but not eat rely on these formulas just as babies who cannot breast feed rely on baby formula to meet their nutritional needs. People who cannot consume anything orally are fed via a tube inserted into the stomach or intestines. Finally, those whose gastrointestinal tracts cannot absorb even liquids are fed intravenously with solutions that provide 100 percent of human nutritional needs.

Examples of Food as a Cause of Disease

Food allergies and intolerances are common medical reasons for eliminating specific foods from one's diet. An allergy is an immune response to proteins in food that the body identifies as foreign. The most common food allergies include those to peanuts, tree nuts, shellfish, milk, soy, corn, wheat, and eggs. Most allergies appear in childhood and require complete elimination of the offending food if the symptoms are to be eradicated. Childhood food allergies may persist for a lifetime or may resolve a few years after getting rid of the offending food. Symptoms of allergies may include rashes and other skin irritations, gastrointestinal inflammation and bleeding, and respiratory distress, which may even involve arrest of breathing.

Food intolerances are not allergies but rather uncomfortable reactions to food that are not generally considered life threatening. One well-known example is lactose intolerance. Lactose is the carbohydrate in milk and other dairy products. The body requires a specific enzyme if lactose is to be absorbed. As people age their bodies may make less of the enzyme necessary to break down lactose and as a result they may experience gastrointestinal distress, including such symptoms as gas or diarrhea, when they consume milk products containing lactose. Most people with lactose intolerance can tolerate dairy products if they accompany their meal with a lactase enzyme pill or if they consume dairy products pretreated with lactase enzyme. Thus, food technology allows people with intolerances to tolerate the offending foods but avoidance is the only option for people with food allergies.

In countries such as the United States where food is abundant, some of the greatest medical risks result from overeating rather than insufficient eating. For example, an excess intake of energy in the form of food leads to an increased risk of obesity. Obesity increases one's risk of cardiovascular disease, cancer, diabetes, and obstructive pulmonary disease—among the most common and most deadly diseases today. Medical practitioners have tried to determine how much food is adequate to support healthy living. People who consume too much food and become obese may seek medical treatment to lose weight and treat diseases resulting from obesity. Treatments may include nutritional therapy, exercise programs, drug therapy, or surgery. Foodborne illness results from eating contaminated food. Foodborne illness can be caused by parasites, bacteria, viruses, toxins, or other pathogens that are harmful to humans. Food is not the direct cause but rather the carrier of the problematic agent. The effects of foodborne illness can range from flulike symptoms to death depending on the type of pathogen and the amount of exposure. Foodborne illnesses are generally prevented by appropriate growing, harvesting, packaging, preparation, cooking, and storage of food. However, many countries lack the technology and resources necessary to accomplish this. Thus, assuring food safety continues to be an area of international concern.

Food as a Treatment

Food is not only necessary to sustain health but it can also help ill people regain health. Although the common advice to "feed a fever" may sound like folklore it is actually based in scientific evidence. A rise in body temperature is required in order to fight disease. People with a fever also require extra energy if they are to have adequate energy to maintain their strength while they battle illness. Likewise, the immune system uses a wide range of nutrients to combat intruders. All infectious diseases result in increased need for nutrition to strengthen the immune system as if fights against invading viruses or bacteria. People who suffer from diseases such as cancer, cystic fibrosis, and acquired immunodeficiency syndrome (AIDS) generally require extraordinarily large amounts of nutrients to battle their disease. Likewise, young children
who are ill require extra food to ensure that they have adequate nutrition to ensure normal growth and development. Food is crucial in combating both minor and major illnesses.

Many specific nutrients defend against disease. Calcium, a mineral found mainly in dairy products, is critical in the promotion of bone health and protection against osteoporosis. Fluoride, now added as a supplement to most water supplies, is crucial to tooth development. Iron is most commonly found in meats and protects against anemia. Folic acid prevents neural tube defects such as spina bifida in developing fetuses and has recently been found to protect against cardiovascular disease. In fact, almost every vitamin and mineral is known to be critical to one or more life processes. Nutritional specialists and medical practitioners are constantly studying the role each nutrient plays in protecting the body and investigating further possible cures.

Margen, Sheldon, and the editors of the University of California at Berkeley Wellness Letter. The Wellness Encyclopedia of Food and Nutrition: How to Buy, Store, and Prepare Every Variety of Fresh Food. New York: Health Letter Associates, 1992.

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Medicine

Medicine

In its broadest sense, medicine denotes ideas relating to diagnoses, causes, and cures of illness, as well as the practice of restoring and maintaining health, and the substances used in the treatment of disease. Medicine is both a domain of knowledge and the application of that knowledge. Medical ideas and practices as well as the social institutions relating to health compose a medical system. Medical systems include ways of classifying disease (cancer, a cold, soul loss, and spirit possession), health specialists (doctors, herbalists, and shamans), and therapies to end illness (pharmaceuticals, meditation, acupuncture, and divination).

Western medicine, or biomedicine, is currently the most widespread medical system, but thousands of others exist throughout the world. Although each tradition is different, diagnosis and treatment often consist of both magical and herbal components. For instance, many societies believe that ill health can be attributed to supernatural forces, which can be meted out by spirits, gods, ancestors, sorcerers, or witches. These forces are capable of causing both the body and the soul to become ill. To combat disease, patients and healers can also invoke magical substances, rituals, or supernatural beings. Another common method of healing is herbalism, using plants to treat illness. An immense variety of plant species are employed as remedies and include decongestants, pain relievers, and antiseptics. Plants in the Americas have been used to derive important drugs including aspirin, quinine, and novocaine. Although nonbiomedical traditions were once regarded as ineffective and superstitious, they are now acknowledged as providing new sources of medicinal plants as well as information regarding the social lives, environments, and experiences of humans.

Medical ideas and practices both constitute and are constituted by social and cultural beliefs and concerns. Arthur Kleinman notes that medicine is a cultural system “of symbolic meanings anchored in particular arrangements of social institutions and patterns of interpersonal interactions” (1990, p. 24). Illness dialogues, diagnoses, and treatments can express ideas regarding religion, morality, power, politics, identity, economics, and gender. Consequently, social scientists are able to examine medical systems and their components as one method of understanding societal norms, attitudes, and practices. For instance, in The Birth of the Clinic (1973) Michel Foucault examines what he calls the “clinical gaze,” to show how medicine is linked to power. In AIDS and Accusation (1992) Paul Farmer explores how AIDS dialogues in the United States and Haiti reflect attitudes of colonialism, capitalism, and poverty. Social science research regarding the conceptions and use of medicine can focus on both local environments and global ones.

The purposeful treatment of illness has probably occurred throughout the entire span of human existence. However, without written records, it is impossible to know for certain what the earliest types of medical treatment were. The first written evidence of medical knowledge, including lists of symptoms, diagnoses, and treatments, comes from Mesopotamia and Egypt, dating to more than four thousand years ago. In ancient Mesopotamia 250 vegetable and 120 mineral drugs were documented (Magner 1992, p. 19). But it is ancient Egypt that can claim both the first real physician known by name, Imhotep (c. 2980 BCE), and later, the first formalized medical system, which included medical schools, medical insurance, sick leave, and registered physicians of both sexes. The ancient Mesopotamian and the Egyptian medical systems also incorporated magical remedies. These were the first of a number of codified medical traditions that developed around the world.

The ancient medical systems of India and China were developed later than those of Mesopotamia and Egypt but they are still practiced today. In India, Ayurveda (the science of life) was intended to maintain health, not simply treat disease. Ayurvedic practitioners believe that health is the result of the balance of three doshas (elemental manifestations in the physical body) that govern body processes. Magner notes that ancient texts list more than one thousand diseases and almost one thousand drugs, and describe advanced surgical procedures including cesarean section, amputation, lithotomy, cauterization, tonsillectomy, and plastic surgery (p. 43). Like Ayurveda, traditional Chinese medicine also views disease as the result of an imbalance in the body, which is composed of yin and yang elements. Doctors often made diagnoses by studying the pulses of patients and were aware that the heart was responsible for circulating blood long before Europeans were. Chinese medicine employs a variety of treatments including more than five thousand medicinal herbs (such as ginseng), acupuncture (inserting needles into the body at specific points), and moxibustion (applying a burning tinder to the skin).

In classical Greece, Hippocrates (460–361 BCE), sometimes called the “Father of Medicine,” wrote that health was the result of a balance between the four humors (basic bodily fluids) of phlegm, yellow bile, black bile, and blood. During the Roman Empire the humoral approach was used by many physicians, including Galen (130–200 CE). His writings were used as important medical texts throughout Rome, the Islamic world, and Europe for centuries. Islamic doctors further embraced and modified the Greek tradition and spread it from Spain to India. The medical writings of the doctor and philosopher Ibn Sina (Avicenna, 980–1037) became standard texts throughout the Arab conquests and Medieval Europe. In Europe it was not until the scientific revolution of the sixteenth and seventeenth centuries that the Greco-Islamic tradition was fully abandoned.

In 1628 William Harvey (1578–1657) challenged the Galenic tradition when he published what was then an unorthodox idea: that the pumping heart moved a continuous flow of blood through the body. Almost one hundred years later the Turkish and African practice of purposefully exposing individuals to mild strains of smallpox to achieve inoculation caught the attention of Europeans and Americans, leading to the development of the first vaccine. Nonetheless, it was not until the nineteenth century that advances in chemistry and medical technology led to the discovery of microbial sources of disease and their cures. This allowed researchers to isolate, treat, and create vaccines for diseases such as tuberculosis, tetanus, cholera, and rabies. The introduction of general anesthesia (1840s) and antisepsis (1870s) precipitated the growth of surgery and hospitals, but it was not until the twentieth century that significant advances were made.

The product of a specific historic and cultural past, bio-medicine is currently used around the globe. The biomedical system includes professional, scientific, educational, legal, financial, and ethical frameworks. Biomedicine can be characterized by a number of features. One is its almost exclusive use of science and technology to fight disease. Unlike many other traditions, biomedicine views disease as caused by only natural factors. Supernatural or magical sources of illness or treatments are absent. Most biomedical treatments involve the use of synthesized pharmaceuticals and some require hospitalization. Furthermore, the physical body, not the soul, is considered to be the only locus of illness. Given its early history, biomedical practitioners often have a tendency to look for and find a single cause of an illness (such as a microbe) and then to treat it with a single cure (such as antibiotics). Deborah Gordon (1988) notes that the scientific approach of biomedicine is not only a way to treat illness; it is also a way of conceptualizing the world.

The focus of biomedicine is illness and not health, which is often defined as the absence of disease. Critics charge that because biomedicine almost exclusively treats the body and disease, it lacks a holistic approach to well-being that engages with the social individual. Patients who feel that biomedicine is not meeting their needs have a number of other therapeutic options from which to choose. In developed counties such as the United States, complementary and alternative medicines are widely used. In 1998 Eisenberg et al. estimated that number of visits to alternative medicine practitioners exceeded the total number of consultations with primary care physicians in the United States. These therapies, which include herbalism, meditation, yoga, massage, acupuncture, aromatherapy, and chiropractic medicine, are used either in conjunction with, or as a substitute for, biomedical treatment. They are often provided by nonlicensed healers and can incorporate religious or non-Western traditions.

Throughout much of the world, the majority of medical consultations are still with traditional healers and not biomedical personnel. Nevertheless, indigenous and local healing traditions are often used in conjunction with bio-medicine. For instance, in India and China, Ayurveda and traditional Chinese medicine, respectively, continue to play important roles in the public health care systems alongside biomedicine. Magner notes that in the 1960s acupuncture anesthesia was used in 60 percent of all surgeries in China (1992, p. 59). Australian Aboriginal people have the choice of going to a biomedical clinic, using local plants as remedies, or consulting local healers to cure spiritual sickness. In Africa herbalists and diviners, as well as doctors and nurses, are regularly consulted. Throughout our history, humans have employed a variety of techniques to treat illness, and this process continues today.

Eisenberg, David, Rodger Davis, Susan Ettner, et al. 1998. Trends in Alternative Medicine Use in the United States, 1990–1997: Results of a Follow-Up National Survey. Journal of the American Medical Association 280 (18): 1569–1575.

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Medicine

World of Forensic Science
COPYRIGHT 2005 Thomson Gale

Medicine

Medicine is one of the branches of the health sciences. It deals with restoring and maintaining health, but is also used in determining the causes of death. It is a practical science that applies knowledge from biology, chemistry, and physics to treat diseases. Biological knowledge is derived from anatomy, biochemistry, physiology , histology, epidemiology , microbiology, genetics, toxicology , pathology , and many other disciplines. Biology forms the basis for understanding how the human body works and interacts with its environment. An understanding of chemistry is required to determine the interactions between different drugs, to detect chemicals in the body, and design drugs for treatment. Physics has an impact on understanding how the body works and on understanding how the various instruments and equipment are used in diagnosis and treatment. The need to understand interactions between all of these areas makes medicine one of the most complex scientific disciplines.

In its early days medicine was not based on science. Many aspects of it were considered forms of magic, encompassing everything from disease causes to treatments. This was because the disease process was not understood. There was no knowledge of infectious agents (such as bacteria and viruses). Therefore, unless the cause of a disease was obvious and visible, sickness was considered a punishment from gods or an interference of an evil spirit. As a result, some treatments were logical, while others were irrational and often involved magic incantations and spells.

The practice of medicine goes back to at least 3000 b.c., when the first written medical records appeared in Mesopotamia. Babylonian medical texts provided the first anatomical descriptions and an early code of conduct for doctors. Their understanding of diseases was very basic; they recognized
trauma and food poisoning , but a lot of the illnesses were still a mystery. Despite advances in anatomy and surgery, ancient Egyptians, as the Babylonians before them, still believed in supernatural causes for many illnesses.

The scientific basis of medicine was laid down by Hippocrates, who rejected magical causes of diseases. He believed in medical examination and keeping detailed records of a disease history. His influence on medicine is present even today, in form of the "Hippocratic Oath," which all new doctors have to take. It sets out ethical guidelines for doctors.

The importance of clinical examination of the patient was made even more important by Claudius Galen, another Greek physician. He worked extensively on anatomy and experimented with live animals.

Great advances in all areas of medicine, especially in epidemiology and hygiene, took place in the middle ages. Avicenna, a Persian physician, was the first to recognize the contagious nature of tuberculosis. In his many works, he gave important advice to surgeons, especially on cancer treatment and advanced use of oral anesthetics (painkillers). Another great advancement of the times was the use of silk thread for stitching wounds, developed by Abul Qasim al-Zahrawi.

A number of scientific discoveries, starting from the late 1800s with the work of E. Jenner, L. Pasteur, R. Koch, A. Flemming and others, established that microbes are the cause of infectious disease; these diseases can be prevented by vaccinations; and there are drugs that can kill the infectious agents (microbes). These findings shaped modern western medicine.

Furthermore, discoveries in physics, such as x rays, ultrasounds, magnetic resonance, and lasers, led to the development of equipment that allows quicker and better diagnosis, as well as easier and safer surgical procedures.

As a result of these scientific and technological changes, the knowledge that medical students have to acquire is immense. Therefore, all doctors learn the same basics but later they have to specialize in narrower areas in order to be highly skilled and able to effectively treat all of the diseases of a particular organ or tissue.

There are doctors specializing in various areas of medicine, such as emergency medicine, intensive care medicine, internal medicine, pediatrics, surgery, neurology, obstetrics, and others. While obstetrics is a relatively narrow area, dealing with childbirth and female health, surgery or internal medicine is further subdivided into sub specializations. Some of those subspecialties are hematology (blood and its diseases), cardiology (heart and cardiovascular system), oncology (cancer), ophthalmology (eyes), orthopedic surgery (mostly skeletal system), or neurosurgery (brain). On the other hand, pediatrics deals with childhood diseases and most of the specialties and subspecialties have their pediatric equivalent. Some doctors specialize in narrow medical fields, while others specialize in areas requiring wide medical knowledge such as sport, aerospace, or forensic medicine.

The most important doctor for the majority of the population is the family doctor (or general practitioner, GP). It is the GP who makes the first examination and keeps a record of the medical history of the patient. He or she also makes an assessment if more tests are required before a diagnosis can be made or if a referral to a specialist is required.

The process of determining the cause of a disease and prescribing treatment is quite complex. It consists of clinical examination, diagnosis, and treatment.

Clinical examination can consist of a number of different aspects, including visual, pathological, toxicological, and genetic analysis. Visual examination addresses the general symptoms: a patient's appearance, heart rate etc. Pathological analysis is often required to identify any non-obvious cause of disease. The tests can include blood or urine analysis, electrocardiogram (ECG), ultrasound, computed tomography (CT) scan, biopsy, histology of removed tissues, or bacteriological analysis of body fluids . Most people have blood and urine tests during their lives. Toxicological analysis is usually carried out on blood, but can be done on tissue samples (bones or hair) and can detect alcohol, certain drugs, toxic metals, and other compounds (for example dioxins). Genetic testing is not usually required for the majority of patients, but in cases of inherited diseases, or genetic predisposition, they can be carried out. Often it is not just the adults that undergo this procedure. Amniotic fluid surrounding the embryo can be tested to determine if a child will develop a life-threatening disease.

Diagnosis is based on the combination of all of the examinations that have been performed and the accumulated knowledge of the doctor. Depending on the illness, it can be quick and simple or time consuming and difficult.

Treatment is the ultimate result of a visit to the doctor. It can include prescription of drugs, surgery,
or special diet. Any treatment can be simple or complex depending on the illness.

Not all doctors treat patients. Pathologists study disease processes. They analyze clinical tests and base their diagnosis on the results. They can work with isolated tissues and samples, or, in the case of forensic pathologists, the deceased. Pathological analysis is very important in the diagnosis of an illness in the case of regular pathology and in determining a cause of death in forensic pathology. Forensic pathology is a part of a forensic medicine, a branch of medicine answering questions important to the law.

Forensic medicine is important in determining the cause of death, time of death , and identification of the remains. This allows doctors to determine the cause of death as accident, suicide, or murder . A forensic pathologist describes the state of the body (decomposition if any), and subsequently examines the body for a cause of death, but also notes any abnormalities found on the surface or in the tissues. The surface of the body is initially checked for the presence of trauma injuries (bruises, broken bones), cuts or stab wounds, thermal injuries (burns), firearm injuries (gunshot wounds), or defensive wounds . An internal examination of the body is carried out on organs or isolated tissues (histology). It might reveal presence of water in lungs (drowning), or asphyxia (lack of oxygen).

The analysis of a corpse is often carried out in the same way as for normal patients using x rays, toxicology, and genetics. Forensic medicine requires great attention to detail and a wide medical knowledge, especially in the areas of anatomy and physiology.

Modern western medicine is not the only existing medical system. There is also traditional medicine and complementary or alternative medicine. Traditional medicine includes folk and indigenous practices. The best known and most widely accepted areas are Chinese medicine and western herbal medicine. Complementary medicine uses non-invasive and non-pharmaceutical methods. Examples of alternative treatments include yoga, chiropractic or osteopathic manipulation, or various massage methods, as well as many others.

The first written evidence of Chinese medicine comes from 1766 b.c. The philosophy of medicine and methods used by Chinese doctors differed widely from those of the ancient Mediterranean and current modern medicine. The Chinese have based their medicine on a philosophy of yin and yang, and on The Five Elements (metal, wood, water, fire, and earth). A healthy person would have a harmonious mix of these elements. Among the practices developed in Chinese medicine are acupuncture, moxibustion (a technique that involves the use of heat, through burning specific herbs, to facilitate healing), and traditional herbal medicines. A physical examination with a doctor can include detailed interview, pulse taking, breath analysis, and tongue inspection. Some of the traditional Chinese treatments are quite widely accepted by modern western medicine, for example acupuncture.

A new approach to practicing medicine is the development of integrative medicine. It combines the modern western practices with alternative treatments. It only accepts methods for which there is scientific evidence for safety and effectiveness. Acupuncture, herbal treatment, music, and massage therapy are just some of the accepted treatments. The aim of this approach is not to just treat the illness, but to provide support to patients and induce their general well-being.

see also Autopsy; Epidemiology; Pathology.

Cite this article Pick a style below, and copy the text for your bibliography.

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medicine

The Columbia Encyclopedia, 6th ed.

Copyright The Columbia University Press

medicine, the science and art of treating and preventing disease.

History of Medicine

Ancient Times

Prehistoric skulls found in Europe and South America indicate that Neolithic man was already able to trephine, or remove disks of bone from, the skull successfully, but whether this delicate operation was performed to release evil spirits or as a surgical procedure is not known. Empirical medicine developed in ancient Egypt, and involved the use of many potent drugs still in use today, such as castor oil, senna, opium, colchicine, and mercury. In spite of their skill in embalming, however, the Egyptians had little knowledge of anatomy.

In Sumerian medicine the Laws of Hammurabi established the first known code of medical ethics, and laid down a fee schedule for specific surgical procedures. In ancient Babylonia, every man considered himself a physician and, according to Herodotus, gave advice freely to the sick man who was willing to exhibit himself to passersby in the public square. The Mosaic Code of the Hebrews indicated concerns with social hygiene and prevention of disease by dietary restrictions and sanitary measures.

Although ancient Chinese medicine was also influenced adversely by the awe felt for the sanctity of the human body, the Nei Ching, attributed to the emperor Huang-Ti (2698–2598 BC), contains a reference to a theory of the circulation of the blood and the vital function of the heart that suggests familiarity with anatomy. In addition, accurate location of the proper points for the traditional Chinese practice of acupuncture implies some familiarity with the nervous and vascular systems. The Chinese pharmacopoeia was the most extensive of all the older civilizations. The Hindus seem to have been familiar with many surgical procedures, demonstrating skill in such techniques as nose reconstruction (rhinoplasty) and cutting for removal of bladder stones.

In Greek medicine the impetus for the rational approach came largely from the speculations of the pre-Socratic philosophers and such philosopher-scientists as Pythagoras, Democritus, and Empedocles. Hippocrates, the father of Western medicine, taught the prevention of disease through a regimen of diet and exercise; he emphasized careful observation of the patient, the recuperative powers of nature, and a high standard of ethical conduct, as incorporated in the Hippocratic Oath. By the 4th cent. BC, Aristotle had already stimulated interest in anatomy by his dissections of animals, and work in the 3d cent. BC on human anatomy and physiology was of such high quality that it was not equaled for fifteen hundred years.

The Romans advanced public health and sanitation through the construction of aqueducts, baths, sewers, and hospitals. The encyclopedic writings of Galen constitute a final synthesis of the medicine of the ancient world. Revered by Arabic and Western physicians alike, his concepts stood virtually unchallenged until the 16th cent. Unfortunately, his prolific researches on anatomy and physiology were not invariably accurate, and reliance on them impeded subsequent progress in anatomy.

The Middle Ages

With the destruction or neglect of the Roman sanitary facilities, there followed a series of local epidemics that culminated many centuries later in the great plague of the 14th cent. known as the Black Death. During the Middle Ages certain monastic libraries, notably those at Monte Cassino, Bobbio, and St. Gall, preserved a few ancient medical manuscripts, and Arab and Jewish physicians such as Avicenna and Maimonides continued medical investigation.

The first real light on modern medicine in Europe came with the translation of many writings from the Arabic at Salerno, Italy, and through a continuing trade and cultural exchange with Byzantium. By the 13th cent. there were flourishing medical schools at Montpellier, Paris, Bologna and Padua, the latter being the site of production of the first accurate books on human anatomy. At Padua, Vesalius proved that Galen had made anatomical mistakes. Prominent among those who pursued the new interest in experimental medicine were Paracelsus, Ambroise Paré, and Fabricius, who discovered the valves of the veins.

The Birth of Modern Medicine

In the 17th cent. William Harvey, using careful experimental methods, demonstrated the circulation of the blood, a concept that met with considerable early resistance. The introduction of quinine marked a triumph over malaria, one of the oldest plagues of mankind. The invention of the compound microscope led to the discovery of minute forms of life, and the discovery of the capillary system of the blood filled the final gap in Harvey's explanation of blood circulation.

In the 18th cent. the heart drug digitalis was introduced, scurvy was controlled, surgery was transformed into an experimental science, and reforms were instituted in mental institutions. In addition, Edward Jenner introduced vaccination to prevent smallpox, laying the groundwork for the science of immunization.

The 19th cent. saw the beginnings of modern medicine when Pasteur, Koch, Ehrlich and Semmelweis proved the relationships between germs and disease. Other invaluable developments included the use of disinfection and the consequent improvement in medical, particularly obstetrical, care; the use of inoculation; the introduction of anesthetics in surgery (see anesthesia); and a revival of better public health and sanitary measures. A significant decline in maternal and infant mortality followed.

Modern Medicine

Medicine in the 20th cent. received its impetus from Gerhard Domagk who discovered the first antibiotic, sulfanilamide, and the groundbreaking advancements in the use of penicillin. Further progress has been characterized by the rise of chemotherapy, especially the use of new antibiotics; increased understanding of the mechanisms of the immune system (see immunology) and the increased prophylactic use of vaccination; utilization of knowledge of the endocrine system to treat diseases resulting from hormone imbalance, such as the use of insulin to treat diabetes; and increased understanding of nutrition and the role of vitamins in health.

In Mar., 1953, at the Univ. of Cambridge, England, Francis Crick, age 35, and James Watson, age 24, announced
"We have discovered the secret of life."
Indeed, they had unraveled the chemical structure of the fundamental molecule of heredity, deoxyribonucleic acid (DNA), giving science and medicine the basis for molecular genetics and leading to a continuing revolution in modern medicine.

Much medical research is now directed toward such problems as cancer, heart disease, AIDS, reemerging infectious diseases such as tuberculosis and dengue fever, and organ transplantation. Currently, the largest worldwide study is the Human Genome Project, which will identify all hereditary traits and body functions controlled by specific areas on the chromosomes. Gene therapy, the replacement of faulty genes, offers possible abatement of hereditary diseases. Genetic engineering has led to the development of important pharmaceutical products and the use of monoclonal antibodies, offering promising new approaches to cancer treatment. The discovery of growth factors has opened up the possibility of growth and regeneration of nerve tissues.

With the surge of general and specialized medical knowledge, the educational requirements of the medical profession have increased. In addition to the four-year medical course and the general hospital internship required almost everywhere, additional years of study in a specialized field are usually required. Similar progress and increased requirements in education are reflected in ancillary professions such as nursing.

Modern Health Care Management

Modern medicine, characterized by growing specialization and a complex diagnostic and therapeutic technology, faces problems in the allocation of capital and personnel resources. Some authorities advocate an increase in the use of paramedical personnel to supervise the care of individuals with common, chronic, or terminal illnesses, leaving the physician in charge of treating curable disease. Others emphasize the physician's responsibility to help patients and families in the overall management of their health problems, many of which are thought to reflect the social ills of living in an urban, industrialized society.

In some countries, such as Great Britain, medical care is under government control and is available virtually without charge to all. In the United States, medical practice is characterized by a patchwork mixture of government and private control. The Kefauver-Harris amendments to the federal Food, Drug, and Cosmetic Act of 1962 empower the Food and Drug Administration to require stricter testing and licensing of new drugs. There have also been federal, state, and local programs for mass vaccination and other public health programs. The Medicare program, enacted in 1965, provides subsidized hospital and nursing-home care for persons over 65 and, with the Hill-Burton Act, provides funds for state aid to the medically indigent (Medicaid).

A wide variety of private medical insurance plans are also available to those who can afford them, and many employers pay all or part of their employees' health insurance premiums. In addition, health maintenance organizations (HMOs), or group practice plans, are designed to promote disease prevention and reduce medical expenditures.

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Medicine

Space Sciences
COPYRIGHT 2002 The Gale Group Inc.

Medicine

Traditionally, space medicine has tackled medical problems associated with the space environment. Increasingly, however, space medicine also encompasses research conducted aboard space stations and vehicles. Medical research conducted in microgravity is making significant contributions to the understanding of the molecular structure of living things—a key to the development of new disease-fighting drugs. The scope of biological molecules includes proteins, polysaccharides and other carbohydrates, lipids and nucleic acids of biological origin, and those expressed in plant, animal, fungal, or bacteria systems. The precise structure of proteins and some other biologic molecules can be determined by diffracting X rays off crystalline forms of these molecules to create a visual image of the molecular structure. Determining the structure of these macromolecules—which allow living
organisms to function—is essential to the design of new, more effective drugs against infectious diseases and other afflictions, such as AIDS, heart disease, cancer, diabetes, sickle-cell anemia, hepatitis, and rheumatoid arthritis.

Medical Advances from Space Research

Space-based crystal growth facilitates the study of how macromolecules work in the human body, which has important implications for medicine. For example, through protein crystal growth research, scientists have made an important step toward developing a treatment for respiratory syncytial virus—a life-threatening virus that causes pneumonia and severe upper respiratory infection in infants and young children. Investigators have determined the structure of a potentially important antibody to the virus, allowing scientists to understand key interactions between the antibody and the virus, thus, facilitating development of treatments. Factor D protein crystals have also been grown in space, leading to development of a drug that may aid patients recovering from heart surgery by inhibiting the body's inflammatory responses. Experiments in protein crystallization research have also yielded detailed structural data on proteins associated with Chagas' disease, a deadly illness that afflicts more than 20 million people in Latin America and parts of the United States.

Medical research in space has likewise yielded precise images of insulin proteins—mapped from space-grown crystals—which can aid the development of new insulin treatments for diabetes. Such treatments would greatly improve the quality of life of insulin-dependent diabetics by reducing the number of injections they require. In addition, a space-based study of the HIV protease-inhibitor complex has resulted in improved resolution of the protein's structure, which has important implications for designing new drugs for AIDS therapies. Microgravity research has also provided insight into an enzyme called neuraminidase, which is a target for the treatment and prevention of the flu. Meanwhile, influenza protein crystals grown aboard several space shuttle flights have had a significant impact on the progress for a flu medicine. As a result, several potent inhibitors of viral influenza (types A and B) have been developed. Medical research in space has also provided insight into fundamental physiologic processes in the human body. A protein crystal growth study conducted during a space shuttle flight shed new light on antithrombin—a protein that controls coagulation of blood.

Research on the International Space Station

Equipped with a dedicated research laboratory, the International Space Station (ISS) will support longer-duration experiments in a more research-friendly, acceleration-free, dedicated laboratory than the space shuttle can allow. Onboard ISS, astronauts and cosmonauts will use the Microgravity Science Glovebox to support investigations and demonstrations in all of the microgravity research disciplines. When it is sealed, the Glovebox serves as a single level of containment by providing a physical barrier. A planned protein crystal growth facility will be used to expose a pure protein solution to a substrate, which draws the liquid out of the protein solution, leaving crystallized proteins behind.

Plans for the ISS also call for a "bioreactor" onboard that will be used in experiments to grow cells and tissues in a controlled environment. On
Earth, bioreactors have to rotate to allow cell growth in three dimensions, very similar to the way cells grow naturally within an organism. However, this works only up to a certain sample size because the larger the sample gets, the faster the bioreactor has to spin to keep the cells suspended. In the microgravity environment of the International Space Station, the cells will remain suspended on their own because there is virtually no gravity to cause sedimentation. As a result, samples can be grown larger and be kept alive for longer periods.

With these cells and tissues, new medicines in the fight against AIDS, cancer, and diabetes can be safely tested, without harming animal or human test subjects, and long-term exposure to microgravity and its effects on human bones, muscles, cartilage, and immunity can be studied effectively. Bioreactor research will also be valuable in the study of potential cartilage and liver tissue transplantation.

see also Careers in Space Medicine (volume 1); Crystal Growth (volume 3); International Space Station (volumes 1 and 3); Made in Space (volume 1).

John F.Kross

Bibliography

Oberg, James E. The New Race for Space. Harrisburg, PA: Stackpole Books, 1984.

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medicine

The Renaissance
COPYRIGHT 2008 Greenhaven

medicine

The practice of medicine in the early Renaissance was still bound by the study of the ancient Greek doctors and writers, in particular Hippocrates, Dioscorides, and the second-century physician Galen. The writings of Galen were the accepted teaching in universities and sanctioned by the Catholic Church, which held control through the universities over the training of professional doctors. Galen's own anatomical knowledge was limited, however, by a prohibition on human dissection, a practice still banned by the medieval church. Thus the limitations of Galen's knowledge persisted for a thousand years within Europe, even as the church held his teachings to be infallible.

A new approach to knowledge and investigation of science bloomed in the Renaissance. Old methods and treatments came under question. The German philosopher Paracelsus was the son of a physician, and one of the most important figures of Renaissance medicine. He believed that sickness resulted from imbalances of essential minerals and chemicals in the body, and prescribed medicines meant to correct these imbalances. He also investigated the action of poisons, and hit upon the idea that a toxic substance, when applied in a limited dose, can cure the body of illness. Paracelsus applied his theories to the treatment of miners, who seemed to have several dangerous illnesses in common that resulted from their occupation and not from the state of their bodily humors (fluids) or their souls.

In the generation of Paracelsus, new treatments for sickness and injuries were developed, which bypassed many of the old superstitions of the medieval age. The French surgeon Ambroise Pare developed the use of ligatures to close battlefield wounds, a method intended to deter infection and avoid the complications caused by sealing wounds with burning irons. Pare set down his findings in Method of Treating Wounds Inflicted by Arquebuses and other Guns, which after its publication in 1545 became a standard medical textbook for military doctors. For the majority of the population, however, medical practice still held to medieval traditions, and spiritual healing was still the most commonplace approach to sickness. Barber/surgeons set bones, pulled teeth, carried out bloodlettings, and performed amputations of infected limbs. Ordinary medical doctors still relied on the philosophy of the four humors of the body (blood, phlegm, yellow bile, and black bile) to diagnose illness and prescribe treatment. Apothecaries and herbalists offered a wide range of plant and animal products to apply or to ingest, mixtures designed to heal disease through their sheer repulsiveness.

The discovery of new land in the Western Hemisphere and Asia also had an important impact on Renaissance medicine, bringing new treatments and medicines to Europe. University professors and doctors put dissection and the new microscope to work to explore the human body, while artists such as Leonardo da Vinci undertook their own investigations in order to render the human body as realistically as possible. The first translation of Galen's work On Anatomical Procedures into Latin was accomplished in 1531 by Johannes Guinter. In this book Galen recommends human dissection, a stand that promoted the practice by doctors and scientists in the late Renaissance. A new age of investigation was opened up, led by anatomists such as Andreas Vesalius, a professor of surgery at the University of Padua, the academic center of medicine in the Renaissance. Vesalius was the first to practice public dissection before students on human corpses. His book On the Structure of the Human Body, first published in 1543, offered detailed and accurate anatomical drawings. These investigations culminated in the discovery of the circulation of the blood by William Harvey, an English doctor who published On the Motion of the Heart and Blood in Animals in 1628.

See Also: Paracelsus

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medicine

med·i·cine
/ ˈmedisən/
•
n.
1.
the science or practice of the diagnosis, treatment, and prevention of disease (in technical use often taken to exclude surgery).
2.
a compound or preparation used for the treatment or prevention of disease, esp. a drug or drugs taken by mouth:
give her some medicine |
your doctor will be able to prescribe medicines. ∎
such substances collectively:
an aid convoy loaded with food and medicine.3.
(among North American Indians and some other peoples) a spell, charm, or fetish believed to have healing, protective, or other power:
Fleur was murdering him by use of bad medicine.PHRASES:give someone a dose
(or taste) of their own medicine
give someone the same bad treatment that they have given to others:
tired of his humiliation of me, I decided to give him a taste of his own medicine.take one's medicine
submit to something disagreeable such as punishment.ORIGIN:Middle English: via Old French from Latin medicina, from medicus ‘physician.’

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medicine

medicine Practice of the prevention, diagnosis and treatment of disease or injury; the term also applies to any agent used in the treatment of disease. Medicine has been practised since ancient times, but the dawn of modern Western medicine coincided with accurate anatomical and physiological observations first made in the 17th century. By the 19th century, practical diagnostic procedures had been developed for many diseases; bacteria had been discovered and research undertaken for the production of immunizing serums in attempts to eradicate disease. The great developments of the 20th century included the discovery of penicillin and insulin, chemotherapy (the treatment of various diseases with specific chemical agents), new surgical procedures including organ transplants, and sophisticated diagnostic devices such as radioactive tracer and scanners. Alternative medicine, such as osteopathy, homeopathy, or acupuncture, some of which are hundreds of years old, is becoming increasingly popular, and some therapies are being accepted within conventional medicine.

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